Evaluation of the you only live once: A resilience-based intervention for reducing risky sexual behaviours associated with HIV infection among youth in South Africa

Author Identifier

Fungai Mbengo


Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Supervisor

Esther Abena Adama

Second Supervisor

Amanda Towell-Barnard

Third Supervisor

Maggie Zgambo



South African youth (aged 15–24 years) remain at high risk of contracting the human immunodeficiency virus [HIV], despite interventional efforts to prevent the disease. Interventions to strengthen resilience or protective factors may avert risky sexual behaviours linked to HIV transmission in youth, but little research has assessed the effectiveness of such interventions. This study referenced resilience theory in evaluating the impact of a resilience-based HIV prevention intervention, You Only Live Once [YOLO], for youth in South Africa. Perceptions and experiences of participants and intervention implementers were also explored.


The study was done at a not-for-profit organisation that implemented the YOLO intervention in Maluti-a-Phofung Local Municipality, South Africa. Guided by pragmatism, an explanatory sequential mixed methods design was employed.

In the first, quantitative phase, a one-group pretest-posttest design was used. Youth completed a self-administered questionnaire at baseline (n = 197) and three months after the intervention (n = 176). Validated risky sexual behaviour questions and the Child and Youth Resilience Measure [CYRM-28] were used to assess participants’ risky sexual behaviours, resilience and protective factors respectively. Data were analysed using R Statistical Software, Version 4.0.2. The impact of the intervention on risky sexual behaviours, and on resilience and protective factors was established using mixed effect logistic and linear regression models respectively.

In the second, qualitative phase, 10 youth and four intervention implementers were interviewed to explore their perceptions and experiences of the intervention. An inductive thematic approach was applied to analyse the qualitative data.

Findings from both phases were integrated narratively using a joint display.


Quantitative analyses suggest that the intervention positively impacted some risky sexual behaviours, and significantly improved resilience and some protective factors. At three months, participants were 68% less likely to have unprotected sex [odds ratio (OR) = 3.102; 95% confidence interval (CI) = 0.959 to 9.912], 22% less likely to regret their decision to engage in sexual activity [OR = 1.278; 95% CI = 0.430 to 3.797] and 0.4% less likely to be pregnant or have made someone pregnant [OR = 1.004; 95% CI = 0.149 to 6.776] than baseline. Also, participants had significant improvements in their scores of resilience [p = 0.013], individual capacities [p = 0.004] and contextual factors that facilitate a sense of belonging [p = 0.007]. However, the intervention did not positively impact multiple sexual partnerships, transactional sex and intergenerational sex. There was limited impact on relationship with primary caregiver.

Qualitative analyses yielded three main themes: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation.

Integrated findings reveal that whereas the quantitative results demonstrate the impact of the intervention on youth, the qualitative data deepen the understanding of these results by indicating the impact of the intervention on youth, how youth accepted the intervention, factors that promoted and hindered implementation of the intervention, and how implementation of the intervention could be improved.


The YOLO intervention has potential to reduce risk of HIV infection among youth in South Africa and similar contexts. However, there are barriers to the implementation of the programme that need to be eradicated to enhance intervention success. Further evaluation of the intervention with a rigorous study design, longer period for follow-up and larger sample is recommended.



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